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Rhode Island Board of Nursing Review – March 17, 2017
Reviewed by Sedation Certification – January 10, 2024
State Sedation Policy – None*
Ketamine – Low dose RI Scope of Practice Guide for Ketamine


For questions contact the State Board of Nursing.

*No direct guidance is offered by the State Board of Nursing regarding the administration of moderate or deep sedation by Registered Nurses within the state of Rhode Island.

See below for guidance on Anesthetic Agents in emergency situations.

Rhode Island Board of Nurse Registration and Nursing Education Policy Statement
Scope of Practice Guide to the Administration of Anesthetic Agents by Registered Nurses

The RI Board of Nurse Registration and Nursing Education is periodically asked for guidance regarding scope of practice issues on a wide variety of topics. It is generally expected that these
questions be answered using the published documents available on the Department of Health/Nursing website. Those documents include, but may not be limited to, the Nurse Practice Act, Nursing Regulations and a decision tree provided to help guide answers to scope of practice questions. There are rare occasions when a topic is complex and continues to pose practice questions despite reference to those tools. The practice of nurses administering medications classified as anesthetic agents by the Food and Drug Administration (FDA) has come before the Board on a number of occasions, from multiple diverse sources. The Board is therefore providing this guidance statement to clarify some of the scope of practice issues that surround this practice.

The RI Board finds that for emergency situations and in licensed, hospital-based emergency departments, it is within the scope of practice for registered nurses to act as the physician’s “third hand” and administer anesthetic agents, in the presence of and under the direction of, a physician or other provider who is properly credentialed in the use of these medications as well as resuscitation and emergency airway management. The term “third hand” assumes the physician ordering the medication is present at the bedside and unable to perform the administration of the medications him/herself due to the circumstances of the environment and/or situation.

Anesthetic agents may also be administered by the registered nurse for relief of refractory symptoms in the patient receiving hospice/end of life care (not including palliative care). Local anesthetic agents may be used for topical, intraosseous, and intramuscular routes when ordered by a physician or APRN/PA for the relief of discomfort from painful injections.

It is within the scope of nursing practice to manage the care of patients receiving IV sedation.
The RI of Board of Nurse Registration and Nursing Education expects:
– that administration of medications classified as anesthetics for the purpose of sedation and analgesia, in all circumstances, requires special attention;
– that the nurse shall not have other responsibilities that compromise the ability to adequately monitor the patient;
– that the physical setting for safe administration is assessed;
– that a qualified airway specialist is immediately available;
– that the nurse may decline administration of the medication if it has been assessed as unsafe under the circumstances.

Rhode Island Board of Nurse Registration And Nursing Education 3-17-2017


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